Situational Correlates of Abstinence Self-Efficacy.

Little is known about the situations that are associated with changes in self-efficacy during an attempt to quit smoking. In this study, 214 smokers used palmtop computers to record momentary self-efficacy ratings and situational context during a quit attempt. Higher urge to smoke and negative affect were associated with reduced self-efficacy. Although alcohol and coffee consumption are associated with heightened lapse risk, they were unrelated to abstinence self-efficacy. Individuals with low baseline self-efficacy generally reported lower self-efficacy across situations, but these differences were more pronounced under conditions of high urge and negative affect. These results suggest that self-efficacy may be reactive to affect-motivational states during a quit attempt. Whether these influences represent cognitive biases or objective risk assessments is not known. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-efficacy and smoking cessation: A meta-analysis.

According to relapse models, self-efficacy (SE), or confidence in one's ability to abstain, should predict the outcome of an attempt to quit smoking. We reviewed 54 studies that prospectively examined this relationship. The relationship between SE and future smoking depended upon the population studied and the timing of the SE assessment. The relationship between SE and future smoking was modest when SE was assessed prior to a quit attempt; SE scores were .21 standard deviation units (SD) higher for those not smoking at follow-up than for those who were smoking. The relationship was stronger (.47 SD) when SE was assessed post-quit. However, this effect was diminished when only abstainers at the time of the SE assessment were included in analysis (.28 SD). Controlling for smoking status at the time of SE assessment substantially reduced the relationship between SE and future smoking. Although SE has a reliable association with future abstinence, it is less robust than expected. Many studies may overestimate the relationship by failing to appropriately control for smoking behavior at the time of the SE assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamic effects of self-efficacy on smoking lapses and relapse among adolescents.

Objective: The present study examined whether dynamic day-to-day variations in self-efficacy predicted success in quit attempts among daily smoking adolescents. Design: A sample of 149 adolescents recorded their smoking and self-efficacy three times per day during 1 week prior to and 3 weeks after a quit attempt. Main Outcome Measures: The first lapse, second lapse, and relapse after at least 24 hours of abstinence from smoking were the main outcome measures. Results: Self-efficacy was relatively high and moderately variable prior to the first lapse, but decreased and became more variable thereafter. Lower self-efficacy as measured at the lapse assessment significantly increased the risk that a second lapse and relapse would occur. Individual differences in baseline self-efficacy did not predict any of the treatment outcomes. The time-varying analyses, however, showed that lower self-efficacy on a given day predicted the first lapse, the second lapse, and relapse on the succeeding day. Daily concomitant smoking (any smoking on the preceding day) was not significantly related to relapse. Conclusion: The present results emphasize the importance of self-efficacy among adolescents in cessation and highlight the need for dynamic formulations and assessments of adolescents' self-efficacy and relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamic Self-Efficacy and Outcome Expectancies: Prediction of Smoking Lapse and Relapse.

According to social learning models of drug relapse, decreases in abstinence self-efficacy (ASE) and increases in positive smoking outcome expectancies (POEs) should foreshadow lapses and relapse. In this study, the authors examined this hypothesis by using ecological momentary assessment data from 305 smokers who achieved initial abstinence from smoking and monitored their smoking and their ASE and POEs by using palmtop computers. Daily ASE and POEs predicted the occurrence of a 1st lapse on the following day. Following a lapse, variations in daily ASE predicted the onset of relapse, even after controlling for concurrent smoking. ASE and POEs generally neither mediated nor moderated each other's effects. These data emphasize the role of dynamic factors in the relapse process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive reactions to tobacco predict relapse after cessation.

Among chronic smokers, individual differences in subjective reactions to smoking may characterize important facets of nicotine dependence that relate to abstinence-induced craving, withdrawal symptom profiles, and risk for relapse. Although the negative reinforcing properties of smoking have achieved prominent positions in models of relapse (Baker, Brandon, & Chassin, 2004), vulnerability to relapse risk may also arise from seeking positive reinforcement from smoking (Shiffman & Kirchner, 2009). In this study, 183 cessation-motivated smokers provided subjective craving, positive and negative reactions to standardized cigarettes following overnight abstinence. Level of craving, negative mood, and positive mood after overnight abstinence were significantly predictive of withdrawal on quit-day. Increased positive reactions to smoking were uniquely predictive of relapse after quitting (Hazard Ratio = 1.22, p     

Psychiatric disorders in smokers seeking treatment for tobacco dependence: Relations with tobacco dependence and cessation.

Objective: The present research examined the relation of psychiatric disorders to tobacco dependence and cessation outcomes. Method: Data were collected from 1,504 smokers (58.2% women; 83.9% White; mean age = 44.67 years, SD = 11.08) making an aided smoking cessation attempt as part of a clinical trial. Psychiatric diagnoses were determined with the Composite International Diagnostic Interview structured clinical interview. Tobacco dependence was assessed with the Fagerstr?m Test of Nicotine Dependence (FTND) and the Wisconsin Inventory of Smoking Dependence Motives (WISDM). Results: Diagnostic groups included those who were never diagnosed, those who had ever been diagnosed (at any time, including in the past year), and those with past-year diagnoses (with or without prior diagnosis). Some diagnostic groups had lower follow-up abstinence rates than did the never diagnosed group (ps OR = .72, p = .02) and those ever diagnosed with more than one psychiatric diagnosis (OR = .74, p = .03) had lower abstinence rates. The diagnostic categories did not differ in smoking heaviness or the FTND, but they did differ in dependence motives assessed with the WISDM. Conclusion: Information on recent or lifetime psychiatric disorders may help clinicians gauge relapse risk and may suggest dependence motives that are particularly relevant to affected patients. These findings also illustrate the importance of using multidimensional tobacco dependence assessments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do resisted temptations during smoking cessation deplete or augment self-control resources?

A resource depletion model of self-control posits that for some period following performance of a task requiring self-control, self-control will be reduced and thus less available for use in a subsequent task. Using 2 substantial data sets collected in real time from individuals who were trying to quit smoking (1,660 and 9,516 temptation episodes collected from 61 and 248 individuals, respectively), we evaluated this model by testing the hypotheses that the number and length of resisted temptations and the intensity of the most recently reported urge during the prior 4 hr predict decreased self-control and increased likelihood of lapsing. Survival and multilevel regression modeling showed that contrary to the hypothesis, the number of recently resisted temptations predicted a lower risk of lapsing in both samples. Duration of resisted temptations had no significant effect in either sample. Intensity of most recently reported urge predicted lapsing in 1 data set but not in the other. Overall, there was little support for the resource depletion model. The protective effect of successfully resisting temptations was an unexpected but provocative finding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contextual correlates of adolescents' self-efficacy after smoking cessation.

Recent research has shown that daily changes in self-efficacy predict lapses and relapse into smoking after quitting among adolescent daily smokers, but it is not known if and how momentary self-efficacy is associated with affect-motivational states and external contexts. In the present study, 134 adolescent daily smokers were monitored daily during 1 week prior to and 3 weeks after they began their quit attempt. Participants completed questions on smoking, self-efficacy, affect-motivational states (craving and negative affect), and external contexts (seeing others smoke, experiencing a stressful event, and alcohol and coffee consumption) three times a day. Affect-motivational states as well as all external contexts (except for coffee consumption) were associated with lower self-efficacy when participants were still abstinent, but also after they had lapsed. Associations between the situational contexts and self-efficacy did not largely depend on individual characteristics such as baseline self-efficacy and age. Among girls, however, the negative associations between self-efficacy and negative affect and drinking alcohol were found to be stronger. These results show that adolescents' self-efficacy during a quit attempt may be responsive to affect-motivational states and external contexts, both before and after lapsing. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Nicotine withdrawal in smokers with current depressive disorders undergoing intensive smoking cessation treatment.

The authors investigated withdrawal in smokers with current threshold and subthreshold depressive disorders (N = 21) who were participating in a pilot study of intensive counseling interventions for smoking cessation. The majority of participants (67%) were taking antidepressants when they entered the trial. Withdrawal symptoms were compared in prolonged abstainers versus nonabstainers across a 12-week treatment period and at the 3-month follow-up assessment visit. Prolonged abstinence was associated with an increase in positive affect and a decrease in depressive symptoms and craving over time. Nonabstinence was associated with little overall change in these variables from treatment onset to the 3-month follow-up. At the 3-month follow-up, 44% of prolonged abstainers were in complete remission of their baseline depressive disorders, compared with 0% remission among nonabstainers. Findings suggest that within the context of an intensive smoking cessation intervention, some smokers with current depressive disorders may experience significant improvement in affective and craving symptoms. Findings also suggest that abstinence may be associated with improvement in affect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating reactivity to ecological momentary assessment during smoking cessation.

Ecological momentary assessment (EMA) consists of assessing phenomena in real time in the natural environment. EMA allows for more fine-grained analyses of addictive behavior and minimizes threats to internal validity, such as recall biases and errors. However, because of the intensive monitoring involved in EMA, measurement reactivity is a concern. To test whether EMA with palmtop personal computers induces reactivity, the authors compared smoking-related outcomes between smokers using EMA and those not using EMA during a quit attempt. The use of no-EMA control groups has been rare in reactivity investigations to date. The EMA protocol included event-contingent assessments (smoking episodes, urge episodes) and random assessments. Outcomes included biologically confirmed abstinence and self-report measures of withdrawal, self-efficacy, motivation, affect, and temptations. Participants were smokers motivated to quit (N = 96). They were randomized to 1 of 3 groups: EMA for the week preceding a planned quit date, EMA for the week following the quit date, and no EMA. Abstinence rates did not differ between the groups at Day 7 or at Day 28 postcessation. For the 20 subscales assessed at each of 3 assessment times, there were significant differences between participants with and without EMA experience for 3 subscales at the 1st of 3 assessment times, and significant differences for 3 different subscales at the 3rd assessment time. These differences suggest some reactivity to EMA, although the inconsistent pattern across time indicates that further research is needed to definitively conclude that EMA induces reactivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lapse-induced surges in craving influence relapse in adult smokers: An experimental investigation.

Objectives: Nearly all smokers who lapse experience a full-blown relapse, but the mediating mechanisms that contribute to this relationship are not well understood. A better understanding of these mechanisms would help to advance more effective relapse prevention treatments for smokers. The purpose of this study is to experimentally evaluate the effects of a programmed smoking lapse on smoking relapse and the effects of postlapse changes in craving on relapse. Method: Adult smokers (n = 63) who quit smoking with a brief cognitive–behavioral intervention and self-help materials were randomly assigned to one of two experimental conditions after 48 h of abstinence: No lapse (a no-smoking control/30-min waiting period) or lapse (smoking two cigarettes of their favored brand during a 30-min period). All participants were then followed daily for 14 days. Craving and biochemically verified self-reported abstinence were assessed on each follow-up day. Time (days) to relapse (7 consecutive days of smoking) was the main dependent measure. Results: Results of Cox regression analysis revealed that participants in the lapse condition relapsed more quickly than participants in the no-lapse condition (hazard ratio [HR] = 2.12, 95% confidence interval [CI] = [1.03, 4.35]). These effects were attributable, in part, to episodic increases in craving among participants in the lapse condition only (HR = 12.42, 95% CI =[2.00, 77.1]). Conclusions: Previously abstinent smokers who lapse are at risk for increased cigarette cravings and consequently, full-blown relapse. These results have implications for both cognitive–behavioral treatments for relapse prevention and for medications designed to help smokers manage cravings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Using SMS text messaging to assess moderators of smoking reduction: Validating a new tool for ecological measurement of health behaviors.

Objective: Understanding the psychological processes that contribute to smoking reduction will yield population health benefits. Negative mood may moderate smoking lapse during cessation, but this relationship has been difficult to measure in ongoing daily experience. We used a novel form of ecological momentary assessment to test a self-control model of negative mood and craving leading to smoking lapse. Design: We validated short message service (SMS) text as a user-friendly and low-cost option for ecologically measuring real-time health behaviors. We sent text messages to cigarette smokers attempting to quit eight times daily for the first 21 days of cessation (N-obs = 3,811). Main outcome measures: Approximately every two hours, we assessed cigarette count, mood, and cravings, and examined between- and within-day patterns and time-lagged relationships among these variables. Exhaled carbon monoxide was assessed pre- and posttreatment. Results: Negative mood and craving predicted smoking two hours later, but craving mediated the mood–smoking relationship. Also, this mediation relationship predicted smoking over the next two, but not four, hours. Conclusion: Results clarify conflicting previous findings on the relation between affect and smoking, validate a new low-cost and user-friendly method for collecting fine-grained health behavior assessments, and emphasize the importance of rapid, real-time measurement of smoking moderators. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Shaping smoking cessation in hard-to-treat smokers.

Objective: Contingency management (CM) effectively treats addictions by providing abstinence incentives. However, CM fails for many who do not readily become abstinent and earn incentives. Shaping may improve outcomes in these hard-to-treat (HTT) individuals. Shaping sets intermediate criteria for incentive delivery between the present behavior and total abstinence. This should result in HTT individuals having improving, rather than poor, outcomes. We examined whether shaping improved outcomes in HTT smokers (never abstinent during a 10-visit baseline). Method: Smokers were stratified into HTT (n = 96) and easier-to-treat (ETT [abstinent at least once during baseline]; n = 50) and randomly assigned to either CM or CM with shaping (CMS). CM provided incentives for breath carbon monoxide (CO) levels OR = 42, 95% CI [5.9, 307]) than with CMS, in which the difference between HTT and ETT participants was not significant. Assignment to CMS predicted membership in the improving (p = .002) as compared with the poor outcomes cluster. Conclusion: Shaping can increase CM’s effectiveness for HTT smokers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life before and after quitting smoking: An electronic diary study.

This article describes a multidimensional, multivariate, and multilevel approach to the assessment of nicotine withdrawal. In this prospective study, 70 adult smokers assigned to an active or placebo nicotine patch condition completed multiple daily assessments using an electronic diary. Average and individual growth curves were estimated for affective and nonaffective withdrawal symptoms. All symptoms but hunger increased significantly on the quit day and remained elevated for three weeks. Variability in symptom experiences across individuals increased from pre- to post-quit. Relations between symptom reports (e.g., negative affect or craving) and episodic events (e.g., stressful events or seeing someone smoke) changed from pre-quit to post-quit. Pre-quit increases in negative affect and quit-day increases in craving were inversely related to abstinence three months after the quit day, suggesting that anticipatory and immediate reactions to quitting influence success. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal analysis of abstinence-specific social support and smoking cessation.

Objectives: (1) To replicate previous research finding that abstinence-specific social support during the active phase of quitting predicts short- and long-term smoking cessation treatment outcome. (2) To describe time-related changes in abstinence-specific support, including how support provided during middle and later phases of the quitting process is associated with treatment outcome. Design: Combined data from three randomized clinical trials of smoking cessation treatment (N = 739) were analyzed using logistic regression and analysis of variance. Main Outcome Measures: Measures included the Partner Interaction Questionnaire (PIQ; Cohen & Lichtenstein, 1990), a measure of smoking-related social support, and smoking status according to 7-day point-prevalence abstinence. Results: Longitudinal analyses found that positive support peaked at week 12, decreasing thereafter. Positive support provided after week 12 did not differentiate between those who never quit smoking, those who quit and relapsed, and those who maintained abstinence. In contrast, negative support was monotonic and was useful at follow-up points for distinguishing between outcome groups. Conclusion: These results suggest that positive and negative support are both important factors in the early phase of quitting, but it is the continued minimization of negative support that best predicts maintenance of nonsmoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of five smoking cessation pharmacotherapies on smoking cessation milestones.

Objective: Most smoking cessation studies have used long-term abstinence as their primary outcome measure. Recent research has suggested that long-term abstinence may be an insensitive index of important smoking cessation mechanisms. The goal of the current study was to examine the effects of 5 smoking cessation pharmacotherapies using Shiffman et al.'s (2006) approach of examining the effect of smoking cessation medications on 3 process markers of cessation or smoking cessation milestones: initial abstinence, lapse, and the lapse–relapse transition. Method: The current study (N = 1,504; 58.2% female and 41.8% male; 83.9% Caucasian, 13.6% African American, 2.5% other races) examined the effect of 5 smoking cessation pharmacotherapy treatments versus placebo (bupropion, nicotine lozenge, nicotine patch, bupropion + lozenge, patch + lozenge) on Shiffman et al.'s smoking cessation milestones over 8 weeks following a quit attempt. Results: Results show that all 5 medication conditions decreased rates of failure to achieve initial abstinence and most (with the exception of the nicotine lozenge) decreased lapse risk; however, only the nicotine patch and bupropion + lozenge conditions affected the lapse–relapse transition. Conclusions: These findings demonstrate that medications are effective at aiding initial abstinence and decreasing lapse risk but that they generally do not decrease relapse risk following a lapse. The analysis of cessation milestones sheds light on important impediments to long-term smoking abstinence, suggests potential mechanisms of action of smoking cessation pharmacotherapies, and identifies targets for future treatment development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attentional bias predicts outcome in smoking cessation.

Most attempts to quit smoking end in failure, with many quitters relapsing in the first few days. Responses to smoking-related cues may precipitate relapse. A modified emotional Stroop task-which measures the extent to which smoking-related words disrupt performance on a reaction time (RT) task-was used to index the distracting effects of smoking-related cues. Smokers (N=158) randomized to a high-dose nicotine patch (35 mg) or placebo patch completed the Stroop task on the 1st day of a quit attempt. Smokers using an active patch exhibited less attentional bias, making fewer errors on smoking related words. Smokers who showed greater attentional bias (slowed RT on the first block of smoking words) were significantly more likely to lapse in the short-term, even when controlling for self-reported urges at the test session. Attentional bias measures may tap an important component of dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contingency management for smoking cessation in adolescent smokers.

This pilot study evaluated the use of contingency management (CM) procedures in combination with cognitive-behavioral therapy (CBT) for smoking cessation in adolescents. Twenty-eight treatment-seeking adolescent smokers participated in a 1-month, school-based smoking cessation program and were randomly assigned to receive either CM with weekly CBT or CBT alone. In the CM+CBT group, biochemical verification of abstinence was obtained twice daily during the first 2 weeks, followed by daily appointments during the 3rd week and once every other day during the 4th week. Participants were monetarily reinforced for abstinence on an escalating magnitude schedule with a reset contingency. At the end of 1 week and 1 month of treatment, abstinence verified using quantitative urine cotinine levels was higher in participants in the CM+CBT group (1 week: 76.7%; 1 month: 53.0%) when compared with the CBT-alone group (1 week: 7.2%; 4 weeks: 0%). These preliminary results provide a strong initial signal supporting the utility of CM techniques for smoking cessation in adolescents and demonstrate the feasibility of implementing such a program in a school setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Situational temptation scores and smoking cessation in general care.

The construct of self-efficacy, which is assessed either in confidence- or temptation-related instruments, presumably predicts transitions between the transtheoretical model stages of change and ultimately smoking cessation outcome. To elucidate its predictive potential for smoking cessation in a general care setting, we examined the association of baseline scores of the situational temptations inventory with month 12 smoking status in 577 heavy smokers participating in a cluster-randomized study of physician training and financial incentives for smoking cessation in Germany. At follow-up, abstinence could be validated in 56 patients. The temptation sub- and total scores were not bivariately associated with altered odds of smoking cessation, in contrast to established predictors like the Fagerstrom test of nicotine dependence and the stages of change. They were associated with the Fagerstrom scores, but not with the stages of change. Controlling for both cessation predictors, in particular the positive/social temptation subscore was associated with quitting. Additional studies are needed to fully understand how situational temptations relate to smoking cessation outcomes and explain variance beyond that of more established predictors of cessation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Short- and long-term smoking cessation for three levels of intensity of behavioral treatment.

Efficacy and costs of 3 levels of medical–behavioral treatment intensity in conjunction with nicotine replacement therapy (NRT) were compared in 240 one-pack-a-day smokers: (a) a low-intensity (LI) group that received 8 weeks of NRT (n?=?80) and 1 advice and education (A&E) session with a nurse practitioner (NP); (b) a moderate-intensity (MI) group that was provided NRT and 4 A&E sessions with an NP (n?=?80), and (c) a high-intensity (HI) group that received treatment combining NRT, 4 A&E sessions, and 12 weeks of individualized cognitive–behavioral therapy (n?=?80). Biochemically confirmed abstinence rates at 9, 26, and 52 weeks posttreatment initiation were highest for the HI (45%, 37%, 35%) group, followed by the LI (35%, 30%, and 27%) and MI (27%, 12%, 12%) groups. Group differences approached statistical significance at 9 weeks and were statistically significant at both 26 and 52 weeks. The cost of LI treatment was $308, that of MI was $338, and the HI treatment cost was $582. (PsycINFO Database Record (c) 2010 APA, all rights reserved)